Application of the Nursing Process
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linked item M6A3: Application of the Nursing Process Paper
Using APA format, the information from this course, and your assigned readings write a six (6) to ten (10) page paper (excludes cover and reference page) addressing the application of the nursing process to a patient care scenario.
A minimum of three (3) current professional references must be provided. Current references include professional publications or valid and current websites dated within five (5) years. Additionally, a textbook that is no more than one (1) edition old may be used.
The paper consists of three (3) parts:
The meaning and use of the nursing process in making good nursing judgments that effect patient care
The development of a plan of care using the nursing process for a specific patient situation
The preparation stage for a teaching plan to prevent a recurrence of a similar situation
The following sheet will assist you when composing the plan of care for the paper: Overview of the Nursing Process.
Patient scenario
A 78-year-old man is living in an assisted living facility. He is able to walk very short distances and uses a wheelchair to transport himself to the communal dining room. He administers his own medications independently and bathes himself. Over the last year he prefers to remain in the wheelchair even when in his room. He has a history of CHF, hypertension, hyperlipidemia and lower extremity weakness. He is able to state his current medications include metoprolol (Lopressor) 50 mg once daily by mouth, furosemide (Lasix) 20 mg once daily by mouth, Quinapril (Acupril) 20 mg once daily by mouth, atorvastatin (Lipitor) 20 mg once daily by mouth.
During a routine examination, his physician noted a pressure ulcer over the ischium on the right buttocks. The wound is oval about 10mm x 8 mm, with red and yellow areas in the middle and black areas on some surrounding tissue. It has a foul odor. The patient had been padding the area so “it doesn’t get my pants wet”. The physician arranged for him to be admitted to the hospital in order for intravenous antibiotic therapy and wound care to be initiated.
After being admitted to the hospital his medications are: metoprolol (Lopressor )50 mg orally every 12 hours, furosemide (Lasix ) 40mg once daily by mouth, quinapril HCl (Accupril) 40 mg once daily by mouth, cefazolin (Ancef)1.5 Grams in 50 mL 0.9 % Normal Saline intravenously three times a day. The result of the wound culture identified Methicilin-resistant staphylococcus aureus. After a surgical debridement of the black tissue a SilvaSorb® dressing was ordered daily.
Part 1 (3-4 pages)
Review the required readings about the nursing process. In your own words, define each step of the process and provide an example for each step.
In the implementation step, what is meant by direct and indirect care as described by the Nursing Intervention Classification (NIC) project?
Discuss the three (3) types of nursing interventions (nurse-initiated, dependent, and interdependent) that applies to the patient care situation. Provide an example of each (refer to your textbook).
Explain how the nursing process provides the basis for the registered nurse to make a nursing judgment that results in safe patient with good outcomes. How does the RN use nursing process to make decisions about priority of care for a single patient and within a group of patients?
Discuss how the registered nurse evaluates the overall use of the nursing process. Identify three (3) variables that may influence the ability to achieve the desire outcomes for the patient.
How is the plan of care modified when the outcomes are not met?
Part 2 (3 pages)
Develop a Plan of Nursing Care for this patient that includes all steps of the nursing process:
One (1) actual NANDA-I nursing diagnosis addressing the priority problem the patient is experiencing. Provide a rationale, with evidence, why this nursing diagnosis is the priority for this patient. What is the assessment data that supports the use of this nursing diagnosis?
One (1) expected outcome that addresses the diagnosis and meets the criteria for an expected patient outcome. Discuss whether the outcome is a cognitive, psychomotor, affective or physiologic outcome. Discuss why the time frame selected for the evaluative criteria was selected. Use evidence as the basis for the time frame and criteria.
Four (4) nursing interventions that includes at least one (1) nurse-initiated, one (1) dependent, one (1) interdependent intervention. Provide a rationale for each intervention that is evidence-based.
Part 3 (1-2 pages)
To assist the patient in preventing a recurrence of a similar incident once he returns to the assisted living environment, the RN needs to develop a teaching plan. Consider the information the information the RN would need prior to development of the plan. Respond to the following and be able to support your answers. You will not be developing a teaching-learning process but demonstrating the ability to prepare for an individualized plan.
How does the RN decide the format of the teaching plan, i.e., written, verbal, or other?
How does the RN know which information needs to be included?
When does the RN determine how and when to evaluate the teaching-learning process?
Compose your work using a word processor (or other software as appropriate) and save it frequently to your computer. Use a 12 font size, double space your work and use APA format for citations, references, and overall format. Assistance with APA citations and references is available through the free resource Citation Machine™. Assistance with APA format, grammar, and avoiding plagiarism is available for free through the Excelsior College Online Writing Lab (OWL). Be sure to check your work and correct any spelling or grammatical errors before you submit your assignment.
You are required to submit your paper to Turnitin (a plagiarism prevention service) prior to submitting the paper in the course submission area for grading. Access is provided by email to the email address on record in your MyExcelsior account during week 2 of the term. Once you submit your paper to Turnitin check your inbox in Turnitin for the results. After viewing your originality report correct the areas of your paper that warrant attention. You can re-submit your paper to Turnitin after 24-hours and continue to re-submit until the results are acceptable. Acceptable ranges include a cumulative total of less than 15% for your entire paper, and no particular area greater than 2% (excluding direct quotes and/or references).
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This activity will be assessed according to the NUR104 M6A3: Application of the Nursing Process Paper Rubric.
SAMPLE ANSWER
Application of the Nursing Process
Introduction
Nursing process is the scientific methodology used by Registered Nurses to perfect provision of quality health care to their patients. The overall nursing process is broken into five distinct steps that include: assessment, diagnosing, care-planning, implementation, and evaluation phases. The process does not always produce expected results, but it can call for its repetition in order to address cons from the process. Therefore, the following article will indulge to discuss the meaning and use of the nursing process in making good nursing judgments that effect patient care. The discussion will also go ahead to describe a plan of care using the nursing process for patient with a history of CHF, hypertension and lower extremity weakness.
The meaning and use of the nursing process in making good nursing judgments that effect patient care
The first phase in the nursing process is the assessment phase. The meaning behind this step is that the RN gathers information about a particular patient’s physiological, psychological, spiritual and sociological status (Timby, 2009). The main method used by RNs to garner this data is through interviews, physical assessment, digging out of patient’s health history and general observation of the patient’s health behavior. This phase completes by documenting the relevant information in retrievable forms. Diagnosing phase follows as the second phase in nursing process. During this phase, The RN involves himself or herself in making an intellectual judgment about the likelihood or actual health disorder with a client (Timby, 2009). This phase can incorporate multiple diagnosis techniques directed to a single client. The diagnosis can be done to a single patient rather to a group of patient if a specific condition from an already disorder in the course of treatment. This assessment not only comprises of actual description of the problem, but also whether or not the patient is susceptible to developing another complication (Timby, 2009). The other reasons behind diagnosis are to gauge patient’s readiness for health improvement and to determine whether or not the patient has developed a syndrome. The meaning of diagnosis phase is crucial is in suggesting the appropriate course of treatment to undertake to that particular diagnosed disorder.
Planning phase is the third step used in nursing process. In this face, plan of action is developed. The plan is developed as a result of patient and the nurse agreeing on the diagnosis Timby (2009). This phase still suggest that if there is multiple diagnosis that need to be addressed, the RN will focus or prioritize each assessment and concentrate to severe symptoms and high risks conditions. For each single problem, it is assigned a clear, measurable objective for the expected beneficial result. In this phase, therefore, Registered Nurse overly refer to the evidence based Nursing Outcome Classification, which is a program of standardized terms and measurements for tracking client wellness.
According to Timby (2009), in the book Fundamental nursing skills and concepts, Nursing Intervention Classification (NIC) can also be employed as a resource for planning. In planning phase, independent nursing interventions are nurse actions started by RN that do not need any direction or any order from another nurse in planning medication for a patient (Timby, 2009).inter-dependent nursing interventions are activities of a RN and other practitioners with sole role of addressing a single factor. Nurse-imitated nursing intervention is a treatment imitated by a nurse in response to a nursing diagnosis.
The fourth phase in nursing process, which is the crucial one, is the implementation phase. During this phase, the RN follows through the already Plan of Action (POA). Timby (2009) argued that the plan is particular to each and every patient and aims at achievable outcomes. Actions and activities involved in a nursing care plan comprises monitoring of the patient for signs of change or improvement, directly caring for the patient or engaging crucial medical roles, educating and giving directions to a patient about further health management, and contacting the patient follow-up (Timby, 2009). The duration in implementation phase can vary and can take hours, days, weeks or even months (Timby, 2009). During implementation phase, indirect care comprises, for example, Emergency Cart Checking and interventions for communities such as social, economic and political aspects. Direct care implies that the patient will have to attend herself or himself with medication without assistance of medical practitioners near him or her.
The last step is provided by Timby (2009), in the book Fundamental nursing skills and concepts, is the evaluation phase which comprises all nursing intervention action that has taken place to the above steps. Once all the intervention activities have taken place, the RN completes an evaluation for client wellness to have been met (Timby, 2009). Possible client outcomes are generally provided under by three terms: patient’s disorder improved, patient’s disorder stabilized, and patient’s disorder deteriorated, died or discharged. If the condition of the client does not show any improvement, or if the set objectives are not met, the nursing process starts afresh and cycle repeats itself (Timby, 2009). The Registered Nurse can evaluate the entire use of nursing process by its outcomes. One of the outcomes to consider is whether the client has been vindicated from the disorder. Another important variable to put into practice in evaluating the process is susceptibility of the patient to develop another disorder from the previous one (Timby, 2009). Most importantly, the RN should be able to evaluate the nursing process by observing outcome of a patient being able to be discharged from the hospital. After the above evaluation of outcomes, the RN can grade the nursing process as either not productive, productive or more productive based on the apparent condition of the client.
The development of a plan of care using the nursing process for a for patient with a history of CHF, hypertension and lower extremity weakness
Timby (2009) contends that the nursing process can assist a RN to develop a plan of care by using its five stages. In the above scenario of a 78-year-old man, the RN will have to gather important information to assist the client. One of the vital data to be recorded is that the man has ability to walk short distances and transports himself to the communal dining room. The man is able to administer himself medication and can bath himself. The RN should also note that the man has a history of CHF, hypertension and lower extremity. Another data to collect is that the client was continuing with direct care. The diagnosis will first begin by rapid assessment of the patient’s personal information. The assessment data that support use of this nursing diagnosis is a pressure ulcer over the ischium on the right buttocks. The other important clinical manifestation is an oval wound about 10mm by 8mm with red and yellow areas in the middle and black areas on some surrounding tissue producing a smelling foul. The doctor uses independent nursing intervention to direct the client to receive intravenous antibiotic therapy so as wound care can be initiated. The outcome that meets the criteria is that similar medication that was dispensed to the man in the first place is still the same one administered after diagnosis. This is because the RN nurse known that development of the wound was as a result of methicillin-resistant staphylococcus aureus. The outcome of the patient is psychomotor because the old man uses his physical abilities and procedures to aid himself to get healed.
The RN uses dependent nursing interventions to prescribe the old man to undergo surgical debridement of the black tissue. Time frame decision was one of interdependent nursing interventions to ensure that there is a connection between earlier medication and the current medication (Timby, 2009). To perfect the medication, the RN uses independent nursing intervention to ensure that the client is administered with saline intravenously three times a day. This period is to ensure complete neutralization of staphylococcus aureus. Implementation will also involve dressing of the wound daily. Evaluation will aim to determine whether SIlvaSorb will heal the entire wound and whether intravenously administered Saline will suppress the activities of Staphylococcus aureus. The RN will also incorporate other medical practitioners in scrutinizing the performance of the wound to see if it would heal. If these symptoms persist, the RN will have to repeat the same nursing process again and find other way to deal with the disorder.
Nursing teaching plan to avoid recurrence of the above condition
To assist the patience in preventing a recurrence of a similar incident once he returns to the assisted living environment, RN will need to develop an individualized plan. In this case, the RN will decide the format of the teaching plan to be in verbal form. The RN comes to this conclusion by the fact that the client can talk, walk for short distances and count transport himself to the communal living room by himself. The information that needs to be included in the plan will include dressing the wound daily with SilvaSorb, saline intravenously three times per day and correct adherence to the prescribed drugs including Metoprolol and others. All this information will be used evaluation where all nursing interventions used converge. Looking into results at the evaluation stage, can guide a registered nurse (RN) to make effective decision on when and how to evaluate teaching-learning process. The appropriate time for RN to determine how and when to evaluate the teaching-learning process is when the patient start demonstrating psychomotor features, that is, ability to use physical skills or procedures. The RN can also determine to evaluate teaching-learning process by identifying priorities of learning needs within the overall plan of care. In this case, the important learning needs is how to change the SIlvaSorb dressing within the prescribed time.
Conclusion
In conclusion, nursing process has to be done tremendously to perfect nursing activities towards provision of quality services to patients. Through the process assessment, diagnosis, planning, implementation, and evaluation, RNs are able to address a particular disorder systematically. If a disorder is not dealt with completely by the process, RNs are advised to use the same nursing process to rectify areas of mistakes, and as a consequence, develop other strategies within the process to holistically eradicate the disorder.
Reference
Timby, B. K. (2009). Fundamental nursing skills and concepts. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
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